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TULSA, OK (918)280-9000

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e-mail / birthday / anniversary club

This is our multi-purpose, register to get it all form.  Please fill it out as complete as possible, so that we can include you in all forums possible.  It is best navigated with the tab button.  Please rest assured that your information is held completely confidential and will not be sold nor intentionally distributed in any fashion.

First Name  Last Name

E-mail Address  Yes, Please Send E-mail Newsletters, Coupons, and Specials to my e-mail address.

Cell Phone Number  Yes, Please Send Text Message Specials.  My wireless phone service is through:

Home/Work Phone Number  Yes, Please contact me via telephone for important events and notifications.  Perhaps I'll leave valuables behind on a visit & I'd like you to be able to reach me.

Fax Number  Yes, Please Send Fax Messages & broadcasts.

In order to send cards for FREE Birthday Dinner up to $10 and FREE Anniversary celebration, we must have your physical mailing address and some very important dates.

Street Number: City:
State:  Zip:  Yes, Please mail me cards, letters, & mailings.

My Birth date:  Our Anniversary Date:

Spouse's First Name: Spouse's Last Name:
Spouse's Birth date:  Spouse's E-mail Address:

Child #1 First Name: Child #1 Last Name:
Child #1 Birth date: Child #1 E-mail Address:

Child #2 First Name: Child #2 Last Name:
Child #2 Birth date: Child #2 E-mail Address:

Child #3 First Name: Child #3 Last Name:
Child #3 Birth date: Child #3 E-mail Address:

Child #4 First Name: Child #4 Last Name:
Child #4 Birth date: Child #4 E-mail Address: